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Irie Y, Wakabayashi H, Matuzawa Y, Hiruta N, Kaneko K. A Case of Anti-Synthetase Syndrome With Anti-Glycyl tRNA Synthetases Antibody Developed After COVID-19. Cureus 2024; 16:e58004. [PMID: 38738103 PMCID: PMC11087665 DOI: 10.7759/cureus.58004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a life-threatening respiratory disease characterized by severe acute infection. In some cases, COVID-19 symptoms may persist for a long term, posing a significant social problem. Long-term COVID-19 symptoms resemble those observed in various autoimmune diseases, such as dermatomyositis and polymyositis. In this report, we present the case of a 55-year-old woman who had been experiencing persistent dyspnea on exertion since contracting COVID-19 a month ago and was subsequently diagnosed with anti-synthetase syndrome (ASS). The patient presented with fever, dyspnea, rash, mechanic's hands, and arthritis. Computed tomography imaging revealed findings indicative of interstitial pneumonia. Immunological test results were positive for anti-EJ antibody, leading to a diagnosis of ASS based on Solomon's established criteria. The patient's condition improved following treatment with prednisolone, tacrolimus, and intravenous cyclophosphamide. Pathological findings of transbronchial biopsy revealed nonspecific interstitial pneumonia with organizing pneumonia, leading to speculation that ASS had developed after COVID-19. Given the scarcity of reports on ASS development post COVID-19, we conducted a literature review and compared our present case to previous ones. This report highlights the importance of considering ASS in the differential diagnosis of patients with long-term COVID-19 symptoms.
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Affiliation(s)
- Yusuke Irie
- Respiratory Medicine, Toho University Sakura Medical Center, Sakura-shi, JPN
| | - Hiroki Wakabayashi
- Respiratory Medicine, Toho University Sakura Medical Center, Sakura-shi, JPN
| | - Yasuo Matuzawa
- Respiratory Medicine, Toho University Sakura Medical Center, Sakura-shi, JPN
| | - Nobuyuki Hiruta
- Pathology and Laboratory Medicine, Toho University Sakura Medical Center, Sakura-shi, JPN
| | - Kaichi Kaneko
- Rheumatology, Toho University Sakura Medical Center, Sakura-shi, JPN
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2
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Diaz-Menindez M, Sullivan MM, Wang B, Majithia V, Abril A, Butendieck RR, Ball CT, Berianu F. Dermatomyositis in Association With SARS-CoV-2 Infection or COVID-19 Vaccine. Arthritis Care Res (Hoboken) 2024; 76:98-104. [PMID: 37728071 DOI: 10.1002/acr.25236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE New-onset and relapsed dermatomyositis (DM) has been reported following SARS-CoV-2 infection or COVID-19 vaccination. This study aims to show the characteristics of a DM cohort after COVID-19 infection and vaccination. METHODS A retrospective review was performed on patients treated for DM between March 1, 2020, and October 31, 2022. Charts were evaluated for the presence of new-onset DM or relapse of preexisting DM following either SARS-CoV-2 infection or COVID-19 vaccination. Data on symptom onset, timing of vaccination, type of vaccination, and disease characteristics were collected. RESULTS Ninety-eight patients treated for DM at our institution in the Division of Rheumatology were included. In total, 12 of 98 patients (12.2%) experienced DM symptoms (either incident or relapse) following either infection or vaccination. Of the 12 patients who developed incident disease or relapse, 7 (58.3%) developed postinfection symptoms, and 8 (66.7%) developed symptoms after vaccination (3 patients had symptoms following both infection and vaccination). The mean onset of symptoms following COVID-19 infection was 3.2 days (median 0.5 days), and mean onset following COVID-19 vaccination was 5.75 days (median 3.5 days). Nine of 12 patients (75%) had a positive myositis-specific antibody, and the remaining 3 (25%) had myositis-associated antibodies. There was no predominant vaccine associated with the development of postvaccination DM symptoms. CONCLUSION This retrospective review revealed a strong temporal relationship between DM symptoms and COVID-19 infection or vaccination in 12.2% of all patients with DM evaluated in our clinic during the pandemic. Additional studies are required to understand the possible pathophysiology behind this association.
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3
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Aschman T, Wyler E, Baum O, Hentschel A, Rust R, Legler F, Preusse C, Meyer-Arndt L, Büttnerova I, Förster A, Cengiz D, Alves LGT, Schneider J, Kedor C, Bellmann-Strobl J, Sanchin A, Goebel HH, Landthaler M, Corman V, Roos A, Heppner FL, Radbruch H, Paul F, Scheibenbogen C, Dengler NF, Stenzel W. Post-COVID exercise intolerance is associated with capillary alterations and immune dysregulations in skeletal muscles. Acta Neuropathol Commun 2023; 11:193. [PMID: 38066589 PMCID: PMC10704838 DOI: 10.1186/s40478-023-01662-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 12/18/2023] Open
Abstract
The SARS-CoV-2 pandemic not only resulted in millions of acute infections worldwide, but also in many cases of post-infectious syndromes, colloquially referred to as "long COVID". Due to the heterogeneous nature of symptoms and scarcity of available tissue samples, little is known about the underlying mechanisms. We present an in-depth analysis of skeletal muscle biopsies obtained from eleven patients suffering from enduring fatigue and post-exertional malaise after an infection with SARS-CoV-2. Compared to two independent historical control cohorts, patients with post-COVID exertion intolerance had fewer capillaries, thicker capillary basement membranes and increased numbers of CD169+ macrophages. SARS-CoV-2 RNA could not be detected in the muscle tissues. In addition, complement system related proteins were more abundant in the serum of patients with PCS, matching observations on the transcriptomic level in the muscle tissue. We hypothesize that the initial viral infection may have caused immune-mediated structural changes of the microvasculature, potentially explaining the exercise-dependent fatigue and muscle pain.
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Affiliation(s)
- Tom Aschman
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
| | - Emanuel Wyler
- Max Delbrück Center for Molecular Medicine, Berlin Institute for Medical Systems Biology, Berlin, Germany
| | - Oliver Baum
- Institute of Physiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Andreas Hentschel
- Leibniz-Institut Für Analytische Wissenschaften - ISAS - E.V, Dortmund, Germany
| | - Rebekka Rust
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Franziska Legler
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Corinna Preusse
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Lil Meyer-Arndt
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ivana Büttnerova
- Department of Autoimmune Diagnostics, Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
| | - Alexandra Förster
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Derya Cengiz
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Julia Schneider
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Claudia Kedor
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Judith Bellmann-Strobl
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Aminaa Sanchin
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Department of Neuropathology, Universitätsmedizin Mainz, Mainz, Germany
| | - Markus Landthaler
- Max Delbrück Center for Molecular Medicine, Berlin Institute for Medical Systems Biology, Berlin, Germany
- Institute for Biology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Victor Corman
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Andreas Roos
- Department of Pediatric Neurology, Faculty of Medicine, University Children's Hospital, University of Duisburg-Essen, Essen, Germany
- Department of Neurology Bergmannsheil, Heimer-Institut Für Muskelforschung am Bergmannsheil, Bochum, Germany
| | - Frank L Heppner
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Cluster of Excellence, NeuroCure, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
| | - Helena Radbruch
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Nora F Dengler
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Opinc-Rosiak AH, Makowska JS. Environmental exposures as risk factors for idiopathic inflammatory myopathies. J Autoimmun 2023; 140:103095. [PMID: 37797402 DOI: 10.1016/j.jaut.2023.103095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/25/2023] [Indexed: 10/07/2023]
Abstract
Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of rare autoimmune diseases, with increasing incidence rates observed in the recent years. The pathogenesis of IIM remains not fully understood, and the interaction of genetic and environmental factors is suspected. It is unclear whether the observed upward trend in the IIM incidence is solely due to improved access to effective diagnostics or perhaps due to increased exposure to external risk factors. The PUBMED database was thoroughly searched for articles describing environmental exposures potentially triggering the onset of IIM. The article summarizes the current knowledge available on this subject, taking into account various environmental factors, including among others UV radiation, infectious agents with SARS-CoV-2, inhaled particles, or iatrogenic effects. Limitations and unmet needs requiring further studies were highlighted.
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Affiliation(s)
| | - Joanna S Makowska
- Department of Rheumatology, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland.
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5
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Zhang Z, Tao W, Cheng D, Qin M, Fu J, Liu D. Deciphering the crosstalk of immune dysregulation between COVID-19 and idiopathic inflammatory myopathy. Front Immunol 2023; 14:1197493. [PMID: 37638007 PMCID: PMC10449257 DOI: 10.3389/fimmu.2023.1197493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Background The coronavirus disease (COVID-19) pandemic is a serious threat to public health worldwide. Growing evidence reveals that there are certain links between COVID-19 and autoimmune diseases; in particular, COVID-19 and idiopathic inflammatory myopathies (IIM) have been observed to be clinically comorbid. Hence, this study aimed to elucidate the molecular mechanisms of COVID-19 and IIM from a genomic perspective. Methods We obtained transcriptome data of patients with COVID-19 and IIM separately from the GEO database and identified common differentially expressed genes (DEGs) by intersection. We then performed functional enrichment, PPI, machine learning, gene expression regulatory network, and immune infiltration analyses of co-expressed genes. Results A total of 91 common genes were identified between COVID-19 and IIM. Functional enrichment analysis revealed that these genes were mainly involved in immune dysregulation, response to external stimuli, and MAPK signaling pathways. The MCODE algorithm recognized two densely linked clusters in the common genes, which were related to inflammatory factors and interferon signaling. Subsequently, three key genes (CDKN1A, IFI27, and STAB1) were screened using machine learning to predict the occurrence of COVID-19 related IIM. These key genes exhibited excellent diagnostic performance in both training and validation cohorts. Moreover, we created TF-gene and miRNA-gene networks to reveal the regulation of key genes. Finally, we estimated the relationship between key genes and immune cell infiltration, of which IFI27 was positively associated with M1 macrophages. Conclusion Our work revealed common molecular mechanisms, core genes, potential targets, and therapeutic approaches for COVID-19 and IIM from a genomic perspective. This provides new ideas for the diagnosis and treatment of COVID-19 related IIM in the future.
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Affiliation(s)
- Zhao Zhang
- Department of Orthopaedics, Xi-Jing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Weidong Tao
- Department of Orthopaedics, Xi-Jing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Debin Cheng
- Department of Orthopaedics, Xi-Jing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Marong Qin
- School of Chemistry, Cardiff University, Cardiff, United Kingdom
| | - Jun Fu
- Department of Orthopaedics, Xi-Jing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Dong Liu
- Department of Orthopaedics, Xi-Jing Hospital, The Fourth Military Medical University, Xi’an, China
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6
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Ursini F, Ruscitti P, Addimanda O, Foti R, Raimondo V, Murdaca G, Caira V, Pigatto E, Cuomo G, Lo Gullo A, Cavazzana I, Campochiaro C, Naclerio C, De Angelis R, Ciaffi J, Mancarella L, Brusi V, Marchetti E, Motta F, Visentini M, Lorusso S, De Santis M, De Luca G, Massaro L, Olivo D, Pellegrini R, Francioso F, Luppino J, Di Cola I, Foti R, Varcasia G, Caso F, Reta M, Dagna L, Selmi C, Iagnocco A, Giacomelli R, Iannone F, Ferri C. Inflammatory rheumatic diseases with onset after SARS-CoV-2 infection or COVID-19 vaccination: a report of 267 cases from the COVID-19 and ASD group. RMD Open 2023; 9:e003022. [PMID: 37328292 DOI: 10.1136/rmdopen-2023-003022] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVES To better define the spectrum of new-onset post-COVID-19 and post-COVID-19 vaccine inflammatory rheumatic diseases (IRD) from a large multicentric observational study. METHODS Consecutive cases of IRD encountered during a 12-month period and satisfying one of the following inclusion criteria: (a) onset of the rheumatic manifestations within 4 weeks from SARS-CoV-2 infection or (b) onset of the rheumatic manifestations within 4 weeks from the administration of one of the COVID-19 vaccines ws recruited. RESULTS The final analysis cohort comprised 267 patients, of which 122 (45.2%) in the post-COVID-19 and 145 (54.8%) in the postvaccine cohort. Distribution of IRD categories differed between the two cohorts: the post-COVID-19 cohort had a higher percentage of patients classified as having inflammatory joint diseases (IJD, 52.5% vs 37.2%, p=0.013) while the post-vaccine cohort had a higher prevalence of patients classified as polymyalgia rheumatica (PMR, 33.1% vs 21.3%, p=0.032). No differences were detected in the percentage of patients diagnosed with connective tissue diseases (CTD 19.7% vs 20.7%, p=0.837) or vasculitis (6.6% vs 9.0%, p=0.467). Despite the short follow-up period, IJD and PMR patients' response to first-line therapy was favourable, with both groups achieving a drop in baseline disease activity scores of ~30% and ~70% respectively. CONCLUSION Our article reports the largest cohort published to date of new-onset IRD following SARS-CoV-2 infection or COVID-19 vaccines. Although causality cannot be ascertained, the spectrum of possible clinical manifestations is broad and includes IJD, PMR, CTD and vasculitis.
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Affiliation(s)
- Francesco Ursini
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Piero Ruscitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Olga Addimanda
- UO Interaziendale Medicina Interna ad Indirizzo Reumatologico, AUSL BO-IRCCS AOU BO, Bologna, Italy
| | - Rosario Foti
- Unit of Rheumatology, Department of Medicine, ARNAS Garibaldi Hospital, Catania, Italy
| | - Vincenzo Raimondo
- Rheumatology Unit, Rheumatology Hospital 'Madonna dello Scoglio', Cotronei, Italy
| | - Giuseppe Murdaca
- Department of Internal Medicine, Ospedale Policlinico San Martino, Genoa, Italy
| | - Virginia Caira
- UO Reumatologia, Ospedale di Castrovillari, Castrovillari, Italy
| | - Erika Pigatto
- Rheumatology Outpatient Clinic, Ospedale Villa Salus, Mestre, Italy
| | - Giovanna Cuomo
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Alberto Lo Gullo
- Unit of Rheumatology, Department of Medicine, ARNAS Garibaldi Hospital, Catania, Italy
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Rossella De Angelis
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Ciaffi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luana Mancarella
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Veronica Brusi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elena Marchetti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Motta
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marcella Visentini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Sebastiano Lorusso
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research and Clinical Unit of Immunorheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico, Rome, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Laura Massaro
- Rheumatology Outpatient Clinic, ASP Cosenza, Scalea, Italy
| | - Domenico Olivo
- Rheumatology Outpatient Clinic, ASP Crotone, Crotone, Italy
| | - Roberta Pellegrini
- UOC Medicina Interna 'M.Valentini', Presidio Ospedaliero 'Annunziata', Cosenza, Italy
| | - Francesca Francioso
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Jessica Luppino
- Rheumatology Unit, Rheumatology Hospital 'Madonna dello Scoglio', Cotronei, Italy
| | - Ilenia Di Cola
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roberta Foti
- Unit of Rheumatology, Department of Medicine, ARNAS Garibaldi Hospital, Catania, Italy
| | | | - Francesco Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Massimo Reta
- UO Interaziendale Medicina Interna ad Indirizzo Reumatologico, AUSL BO-IRCCS AOU BO, Bologna, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - Roberto Giacomelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research and Clinical Unit of Immunorheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico, Rome, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Precision and Regenerative Medicine-Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | - Clodoveo Ferri
- Rheumatology Unit, Rheumatology Hospital 'Madonna dello Scoglio', Cotronei, Italy
- Rheumatology Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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Didona D, Solimani F, Caposiena Caro RD, Sequeira Santos AM, Hinterseher J, Kussini J, Cunha T, Hertl M, Didona B. Dermatomyositis: a comprehensive review of clinical manifestations, serological features, and therapeutic approaches. Ital J Dermatol Venerol 2023; 158:84-98. [PMID: 37153943 DOI: 10.23736/s2784-8671.23.07458-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Dermatomyositis (DM) is an autoimmune disorder, which belongs to a group of rare autoimmune dermatoses characterized by different skin features and variable muscle involvement. We recognize four main variants of DM: classic DM, clinically amyopathic DM, paraneoplastic DM, and juvenile DM. Clinically, patients show several skin features, but heliotrope rash, and violaceous papules located at the interphalangeal or metacarpophalangeal joints (Gottron's papules) are the most frequently observed. Together with skin features, patients show muscle involvement, most commonly with symmetrical weakness of the proximal muscles. DM belongs to the facultative paraneoplastic dermatoses and a wide range of solid or hematologic malignancies can be detected in DM patients. Serologically, a wide range of autoantibodies can be detected in patients with DM. Indeed, distinct serotypes can be related to specific phenotypes with specific clinical features, carrying a different risk for systemic involvement and for malignancies. Systemic corticosteroids are still considered the first-line approach, but several steroid-sparing agents, such as methotrexate, azathioprine or mycophenolate mofetil, have been reported as effective in treating DM. Furthermore, new class of drugs, such as monoclonal antibodies, purified immunoglobulins or Janus kinase inhibitors are becoming more relevant in the clinical practice or are currently under investigation. In this work, we aim to offer a clinical overview of the diagnostic workout, the characteristics of DM variants, the role of autoantibodies in DM, and the management of this life-threatening systemic disorder.
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Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany -
| | - Farzan Solimani
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin BIH, Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Julia Hinterseher
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany
| | - Jacqueline Kussini
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany
| | - Tomas Cunha
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany
| | - Biagio Didona
- Department of Dermatology, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, Rome, Italy
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8
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Sin DD. Is long COVID an autoimmune disease? Eur Respir J 2023; 61:61/1/2202272. [PMID: 36634924 DOI: 10.1183/13993003.02272-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/10/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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9
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COVID-19 Related Myocarditis and Myositis in a Patient with Undiagnosed Antisynthetase Syndrome. Biomedicines 2022; 11:biomedicines11010095. [PMID: 36672603 PMCID: PMC9856070 DOI: 10.3390/biomedicines11010095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The clinical presentation of SARS-CoV-2 varies from patient to patient. The most common findings noted were respiratory tract infections, of different severity grades. In some cases, multi-organ damage was noted. Due to its high potential for causing severe systemic inflammation such as myositis and myocarditis, patients should be properly investigated, which carries high chances of SARS-CoV-2 being easily missed if not investigated on time and which can result in more fatal outcomes. CASE REPORT We present a case of COVID-19 infection in a non-vaccinated male patient, who presented to our clinic with no symptoms of respiratory involvement but with severe muscle aches. Cardiac markers and procalcitonin levels were high, and concentric hypertrophy of the left ventricle, severe hypokinesia of the interventricular septum and of the antero-lateral wall, hypokinesia of the inferior and posterior wall and an ejection fraction of the left ventricle being around 34% was noted. Coronary angiography showed no lesions. Corticosteroids and antibiotics were instituted which showed improvement. A possible link to an autoimmune process was suspected, due to the presence of anti-PL-7 antibody, suggesting an antisynthetase syndrome. CONCLUSION Each and every patient should be thoroughly investigated, and presently little is known in regards to this virus. Studies focusing on possible relationships between the COVID-19 and autoimmune disease can help to potentially generate better outcomes.
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